Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Edward P. Monico

Second Advisor

Lori A. Post

Subject Area(s)

Medicine, Law

Abstract

In investigating information transfer during the discharge against medical advice (AMA) conversation, this research examined the ability of providers to transfer the appropriate quantity and quality of information to allow patients to make an informed decision. Additionally, the research determined an updated rate of AMA discharges. A retrospective chart review was completed utilizing an eight-point screening tool created from policy and literature standards to measure documentation sufficiency over a one-year time interval. Data analysis indicated that healthcare providers documented medico-legal standards the following percentages of the time: (1) capacity (22.0%); (2) agreement of the signs and symptoms determined by documentation of the diagnosis (33.0%); (3) the extent and limitation (8.1%) of the evaluation; (4) documentation of the current treatment plan, risks, and benefits (3.8%); (5) risks and benefits (4.8%) of foregoing treatment; (6) alternatives to suggested treatment (5.7%); (7) an explicit statement the patient left AMA as well as stating what the patient was refusing (50.7%); and, (8) follow-up care including discharge instructions (67.5%). An AMA discharge rate was calculated to be 0.52%. These results show that physicians are not conducting AMA encounters according to quality and safety domains set by oversight institutions and federal requirements. The calculated discharge AMA rate is lower than published studies suggesting the need to standardize the definition of AMA. Future interventions should standardize the discharge procedure with emphasis on provider education to increase safety and quality of care.

Comments

This is an Open Access Thesis.

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